Electrocardiograms (ECGs or EKGs) are among the most commonly performed diagnostic tests in both primary care and cardiology practices. Yet despite their routine use, billing for EKG services is often misunderstood—especially when deciding whether to use 93000, 93005, or 93010.
Incorrect code selection is one of the biggest reasons for denials, underpayments, and payer recoups. This guide breaks down everything providers need to know about billing EKGs correctly, documenting appropriately, and meeting payer-specific requirements.
What Is an Electrocardiogram (ECG/EKG)?
An ECG records the heart’s electrical signals using multiple skin electrodes. It helps evaluate arrhythmias, ischemia, structural abnormalities, electrolyte disturbances, and response to medications. Strengthen your cardiac imaging workflows with our expert CPT 93306 Complete Echocardiogram Billing Guide
From a billing standpoint, the test can be billed globally or broken into separate components:
- Technical component (TC) — placing leads, operating the machine, producing tracing
- Professional component (PC) — interpreting the results and issuing a report
This is why the CPT codes for EKGs differ based on who performed which component.
CPT Code Breakdown (93000 vs 93005 vs 93010)
CPT 93000 — Global Electrocardiogram
Description:
“Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report.”
Use this code when:
- Your practice performs both the technical work and the interpretation.
- The provider documents a full interpretation with a signed report.
Typical settings:
- Primary care clinics
- Cardiology practices
- Urgent care
- Internal medicine offices
Most outpatient practices use 93000 by default because both components are usually done in-house.
Eliminate non-Doppler echo denials by following the steps in our CPT 93307 Transthoracic Echocardiogram Billing Guide
CPT 93005 — Tracing Only (Technical Component)
Description:
“Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report.”
Use this when your practice only performs the test, and the interpretation is done elsewhere, such as:
- The ECG is sent to a cardiologist
- A hospital-employed physician interprets it
- A remote cardiology service reads the tracing
This is common in rural or telemedicine-supported clinics.
93005 represents the technical component only and must not be billed with 93000.
CPT 93010 — Interpretation Only (Professional Component)
Description:
“Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only.”
Use 93010 when:
- The provider reads and interprets an ECG performed elsewhere
- The tracing arrives from an ER, urgent care, ambulance, or remote clinic
- Only the written report and medical decision-making are provided
Cardiologists frequently bill 93010 when interpreting studies for hospitals or affiliated clinics.
When to Use Each Code: Quick Decision Chart
ScenarioCorrect Code
Office performs EKG + provider interprets 93000
Office performs EKG only (no interpretation) 93005
Provider interprets EKG only 93010
Two providers involved (one does tracing, one interprets) 93005 + 93010
The hospital performs an EKG, and the cardiologist interprets 93010 only
Telecardiology read 93010
Documentation Requirements
To bill an EKG correctly, documentation must include:
For 93000 (global service):
- Date of service
- Indication (reason for test)
- Confirmation that 12 leads were used
- Completed tracing
- Provider’s signed interpretation report
- Clinical assessment and any recommended actions
For 93005 (technical only):
- Date and time EKG performed
- Confirmation of lead placement
- Technician signature
- EKG tracing (attached or uploaded in EHR)
For 93010 (interpretation only):
A compliant EKG interpretation must include:
- Rhythm
- Rate
- Axis
- Intervals
- ST-T wave changes
- Comparison to prior EKGs, if available
- Clinical impression
- Provider signature
Incomplete or templated interpretations are a top reason for audits and takebacks—especially from Medicare. Reduce billing errors with our essential CPT 93308 Limited Echocardiogram Billing Guide for cardiology practices.
Common Payer Restrictions and Nuances
Insurance rules vary, but these are the most consistent requirements across payers:
1. ECG must be medically necessary
Payers deny EKGs billed for:
- Routine physical exams
- Administrative clearance (employment, sports, DOT)
- Non-symptomatic or screening purposes, unless justified
Examples of acceptable ICD-10 codes include:
- R07.9 (Chest pain)
- R00.2 (Palpitations)
- R06.02 (Shortness of breath)
- I10 (Hypertension)
- I48.91 (Atrial fibrillation)
2. Same-day EKG + office visit may require modifier -25
If the provider bills:
- 99213 + 93000
- or
- 99214 + 93010
Some payers require modifier -25 on the E/M code.
3. Medicare requires a full interpretation report
Medicare is strict:
A waveform alone is NOT enough.
There must be a complete written report signed by the interpreting provider.
Maximize reimbursements with our detailed CPT 93015 Cardiac Stress Test Billing Guide—built for accuracy and compliance.
4. Medicaid rules vary by state
Some Medicaid programs routinely deny:
- Global EKGs without a clear necessity
- Missing interpretation report
- EKGs billed during preventive visits without symptoms
5. Commercial insurers may bundle EKGs
Some carriers bundle EKGs with annual exams or pre-op visits unless justified by symptoms.
Reimbursement Rates (Approximate)
(Actual rates vary by region and payer.)
- 93000: $15 – $30
- 93005: $5 – $10
- 93010: $10 – $20
Hospital rates may be higher under facility fee schedules.
Common Billing Mistakes to Avoid
❌ Billing 93000 when only interpretation was done
Use 93010 instead.
❌ Missing or incomplete interpretation
This is the #1 reason Medicare recoups EKG payments.
❌ No documentation of medical necessity
“Routine EKG” = denial.
❌ Wrong pairing with E/M codes
Some EHRs automatically bundle incorrectly.
❌ Billing global + interpretation together
93000 must NOT be paired with 93010 on the same date by the same provider.
Real-World Examples
Correct Example
A primary care office performs an EKG due to palpitations.
The provider interprets and documents findings.
→ Bill 93000
Correct Example (Two-provider scenario)
The clinic performs the tracing.
A cardiologist interprets remotely.
→ Clinic bills 93005
→ Cardiologist bills 93010
Incorrect Example
EKG performed during a routine physical without symptoms.
→ Likely denied as screening.
Final Thoughts
EKG billing appears straightforward, but incorrect code selection and incomplete documentation lead to frequent denials and revenue loss. Understanding the difference between 93000, 93005, and 93010 helps ensure accurate reimbursement and compliance.
If your practice struggles with cardiology or primary care billing, Global Tech Billing LLC helps clinics establish compliant workflows, review documentation, and reduce denials for cardiovascular services.
Understand supervision rules clearly using our CPT 93016 Stress Test Supervision Billing Guide for cardiologists and NPPs.
FAQ: Common Questions About 93000, 93005, and 93010
1. Can nurse practitioners bill 93000?
Yes. If they perform and interpret the ECG, they may bill 93000.
2. Can I bill 93000 during an annual physical?
Only if medically necessary and properly documented. Otherwise, insurers deny it as “screening.”
3. Is 12-lead confirmation required?
Yes — all ECG codes require at least 12 leads.
4. Can two providers bill EKG codes on the same day?
Yes—one for 93005 (technical) and one for 93010 (interpretation).
5. Do telehealth EKGs qualify?
Only if the tracing is produced in person. Interpretation (93010) may be done remotely.
6. What happens if the provider only writes “Normal EKG”?
That is not an acceptable interpretation and may result in recoupment.
7. Can cardiologists bill for repeated EKGs on the same day?
Medicare typically allows one unless clearly justified.
